5501 Bardstown Rd
Louisville KY 40291
Medical School: Other - Unknown
Accepts Medicare: No
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Participates In PQRS: No
Participates In EHR: No
License #: 4522
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Thoracic transdural spinal cord herniation at a level caudal to prior discectomy. - Acta neurochirurgica
To outline a scenario of acquired transdural spinal cord herniation not previously described. The authors report their experience with a patient found to harbor a thoracic transdural spinal cord herniation at the disk space immediately caudal to a prior discectomy. Documentation of the radiographic progression of this patient's spinal cord herniation is presented, spanning the course of 13Â years. The patient underwent intradural repair of his dural defect via a lateral extracavitary approach. The herniated spinal cord was successfully reduced. The patient had modest improvement in his symptoms at 2-year follow-up. To the best of the authors' knowledge, this case represents the first reported case documenting this anomaly at a level adjacent to that of a previous surgery within the thoracic spine.
Emergency reversal of anticoagulation and antiplatelet therapies in neurosurgical patients. - Journal of neurosurgery
Intracranial hemorrhage (ICH) is a common problem encountered by neurosurgeons. Patient outcomes are influenced by hematoma size, growth, location, and the timing of evacuation, when indicated. Patients may have abnormal coagulation due to pharmacological anticoagulation or coagulopathy due to underlying systemic disease or blood transfusions. Strategies to reestablish the integrity of the clotting cascade and platelet function assume a familiarity with these processes. As patients are increasingly treated with anticoagulants and antiplatelet agents, it is essential that the physicians who care for patients with ICH understand these pathways and recognize how they can be manipulated to restore hemostasis.
Thoracolumbar spinal deformity in achondroplasia. - Neurosurgical focus
The authors review the management of thoracolumbar kyphotic deformity in cases of achondroplasia. The presence of angular thoracolumbar kyphosis in achondroplasia is well recognized. In children this is initially a nonfixed deformity that persists, however, in more than 10% of individuals and becomes a fixed thoracolumbar kyphotic deformity. Additionally, with the coexistent spinal canal stenosis, neurological damage can occur and manifest as spinal cord or cauda equina compression. The nature of this condition, the natural history, and management options are discussed. Anatomical and biomechanical factors relevant to the condition are specifically highlighted. Avoidance of pitfalls in the management of these patients is discussed for both pediatric and adult patients.
Avoidance of structural pitfalls in spinal meningioma resection. - Neurosurgical focus
Creating a surgical avenue through which to resect an intraspinal meningioma requires dissection of the musculoligamentous structures of the spine. Variable vertebral components must be removed to create a corridor to the intraspinal compartment. The cardinal principles of intraspinal tumor resection are to minimize the intraoperative risk of deformation and traumatic injury of the spinal cord. Therefore, the appropriate planning for access to and removal of the osseous elements is critical. Of equal importance is the consideration of the biomechanics of the spine. In cases of potential spinal instability instrumentation-assisted fusion should be performed at the time of tumor resection. The authors discuss the techniques for creating access to these tumors and propose a simple classification scheme to assist with this decision-making process.
Lumbar myofascial flap for pseudomeningocele repair. - Neurosurgical focus
Initial management for lumbar pseudomeningoceles entails the closed external drainage of cerebrospinal fluid (CSF) with or without blood patch application. The presence of longstanding pseudomeningoceles and those associated with nonmicroscopic dural tears can be more problematic. Additionally the failure of nonoperative measures may necessitate surgery. Ideally the procedure should involve repairing the dural defect, removing the encapsulated cavity of the pseudomeningocele, and obliterating the extraspinal dead space to minimize the recurrence of the problem.The authors describe a technique performed in 12 patients with large (> 5-cm-diameter) pseudomeningoceles referred for management following the failure of less aggressive measures. Diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. They were treated between July 1990 and July 1998. The cause of the pseudomeningoceles was lumbar discectomy (four patients), lumbar decompression (one patient), lumbar decompression and placement of instrumentation (five patients), and intradural procedures (two patients). Their mean age was 47.9 years (range 20-67 years), and they presented at a mean of 5.5 months postoperatively (range 3 weeks-37 months). In all cases there was a satisfactory repair of the pseudomeningocele, dead space obliteration, and long-term symptomatic resolution.Lumbar myofascial advancement for this problem is a useful technique in cases of symptomatic pseudomeningoceles. This technique requires the medial advancement of the musculofascial units of the paravertebral muscles for a layered closure over the exposed spinal canal with obliteration of the pseudomeningocele.
Abnormal coagulation studies associated with levofloxacin. Report of three cases. - Journal of neurosurgery
Complications arising from antibiotic use are of interest to neurosurgeons because many neurosurgical patients are treated for infection. In this report, the authors describe three patients with spine disorders who developed coagulopathies after treatment with levofloxacin, an antibiotic commonly used by neurosurgical services. Three patients with spine disorders developed urinary tract infections (UTIs) for which they received a 3-day course of oral levofloxacin. Subsequently, they demonstrated prolonged prothrombin times and increased international normalized ratios. One of those patients later developed acquired von Willebrand syndrome during surgery. Coagulopathies were successfully corrected preoperatively with parenteral vitamin K. The patient with acquired von Willebrand syndrome required multiple transfusions. There seems to be an association between levofloxacin and coagulation abnormalities in neurosurgical patients treated for UTIs. Neurosurgical services prescribing this common antibiotic should be aware of this problem.
Titanium cage reconstruction after cervical corpectomy. - Journal of neurosurgery
The authors evaluated the efficacy of titanium cage- and anterior cervical plate (ACP)-augmented fusion for reconstruction following decompressive cervical corpectomy in nontraumatic disease.Forty-five patients ranging from 37 to 77 years of age underwent anterior cervical corpectomy followed by titanium cage-assisted reconstruction in which the cages were filled with autologous bone obtained from the resected vertebral bodies (VBs). Plates were placed in all patients. Follow-up radiographic evaluation included computerized tomography scanning and plain flexion-extension radiography. Fusion was demonstrated in all but one patient without reconstruction-related complications. The single complication involved an endplate VB fracture with pistoning of the cage into the VB. The mean follow-up period was 12.9 months.Autologous corpectomy bone-filled titanium cages supplemented with ACPs are an effective means of reconstruction after compressive cervical corpectomy. This technique provides a reasonable alternative to procedures involving long solid strut grafts obtained from the bone bank or from the patient.
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5501 Bardstown Rd Louisville, KY 40291
9342 Cedar Ctr Way Cedar Springs Retail Center